Pharmacology of Gastrointestinal Drugs 22/03/2007

16:57:00
 Understand all the medications used in this area as we as NDs will
encounter them with our patients
 When look at lining of ST there is a protective mucous layer
 Prevents ulcers from forming on the surface of the mucosa
 Rapid cell renewal to that if there’s any damage, rapid repair
 Various chemicals that help in terms of protection
 The formation of ulcers occur when there are imbalances
 Why important to treat gastric ulcers
• If bleed from ulcers have serious consequences, ie bleeding into gut
 Symptoms of PUD
• When mild  complain of epigastric pain
• Gnawing usually after meals
 Risk Factors for PUD
• Bacterial infection (H.pylori)
• Diet
• Stress (emotional)
• Increased age
• NSAIDs – inhibit prostaglandin synthesis
• Cigarette smoking – inhibits ucler healing
• Blood type (type O)
 Treatment of PUD
 Proton Pump Inhibitor
• Oeprazole, Lansoprazole, Pantopraole, Esomeprazole and
Rabeprazole
• If able to absorb it, all medications will be about the same
• Don’t use in pregnant patients (spontaneous abortion)
 Zantac
• Main one that we’ll probably see
• Can get lower doses OTC
• Main H2 agonist that is used in clinical practice
• Used to treat duodenal ulcers
• Not that efficacious in treating gastric ulcers
• b/c it is a selective inhibition
• Ketoconazole – antifungal used in yeast infections or fungal toe
infections
 Antacids
• every antacid is made up of the same chemical ingredients
• neutralizes acids and benefits prostaglandins
 Aluminum
• Can be poorly tolerated b/c of bad chalky taste
• Associated with Alzheimer’s b/c of buildup of aluminum
 Calcium
• Don’t take too much – hypercalcemia
• Thyroid supplements – separate from Ca usage it. D
 • Vit. D
• Increases Ca absorption in the blood streatm
 Sucralfate
• Not associated with Alzehiemer’s
• Effeicacious in treating Duodenal ulcers
• Has many drug interactions
• If take the two fo theme together, block medications from being
absorbed
 Helicobacter Pylori
• Various methods to try and eradicate the H.Pylori
• Taking many capsules throughout the day so now it’s organized into
blister packets
 Ulcer propylaxis
• H.ylori handled more as an outpatient
 PUD Case
• Find out about drug Hx
• Recommend that they see family Doc if they continue to have
symptoms
 Constipation
• Definition is different based on what’s normal or abnormal for
patient
• Constipating drugs
o Tylenol 3
o Calcium
o Iron
 o Aluminum
o Anticholinergic
 Amitryiptyline
 Cause dryiness in mouth and stools
o Inactiviy
o Metabolic or endorine disturbances
• Non-pharmacological measures
o Diet
 Prunes
o Increase fluid intake and water intake
 Pharmacological Treatment of Constipation
 Osmotic Laxatives
• Bring in a lot of fluid and softening the stool
• Causes increase in the motion of the stool
• On avg. 3 to 24 hrs
• End up having very loose/watery stools
 Contact (Stimulant) Laxatives
• Abused the most b/c work so well
• Chronic usage – bowels forget how to have a bowel movement
• Bowels will lose their tone
 Emollient Laxatives
 • They soften the stools, but not stimulate the bowels
• Changes consistency of the stools
• Takes a while to work
• Generally well tolerated
• Used this a lot in people’s straining  those who’ve recovered from
an HT or post partum
 Glycerin suppository
 Laxatives and Nat. Med
• Don’t use Casara and lax together
 Diarrhea
• Diet – sensitivities to some foods
 Loperamide
• Sedation is mild unless take high doses
• Immodium is readily available
• If infectious cause, let the infection pass rather than taking
immodium – get to root cause
 PeptoBismal
• Used to treat H.pylori infection b/c has anti-microbial properties
• Don’t want to use too high of a dose b/c
 Diarrhea Case
• Has she traveled anywhere – infectious causes
• Any other symptoms?
• What other drugs she’s on
 • Abdominal pain from the diarrhea
• Any blood in the stools?
 Nausea
• Cortex, GI, vestibular connection
 Transderm
• Comes in a patch, put behind people’s ear
• Need to put on preventatively and not when the nausea starts
• Can leave it on for three days
• Has anticholinergic type effects
o Constipation
o Dryness of mouth
o Can have local irritation (rash)
 Ondasetron
• SSRI
• Specifically for nausea
• H5T receptors elsewhere
• Can cause some sedation, but a lot less
• Can have problems w.r.t. constipation
• Anything that will reduce it’s metabolism
o St. John’s Wort
• Not used for those in chemo
 Gravol
• Has some antihistaminic type of properties
• Have tablets, rectal, IV…
• Takes approx 30 min to kick in
• Want to avoid anything that depresses the CNS
 Stemetil
• At higher doses used as an antipsychotic
• Not used for a long time, b/c newer agents to treat pychosis
• Generally not the drug of choice, but does provide an option
• Cigarette smokers – will need to use higher dose with them
 Nausea Case
• Suggestions to treat nausea
o Nausea
• Transderm (if takes before he goes on cruise), Gravol, lemon balm,
c-bands
 Cholesterol Synthesis
• Chol is impotant in body for cell tissues
 Canadian
• The higher the LDL the worse the outcome
 Statin
• Decreasing the amount of LDL in the blood
• VLDL receptor – take in more VLDL. Decreases serum LDL
 • Inhibits enzyme HMGCoaAse enzyme
• Potent chol. Lowering effect, but depends on type of statin you have
• Most studies done were done my pfizor which has Liitor
• Decreases LDL 18 55%
• Be cautious of patients with renal impairment
• Can cause a hepatitis or toxicity within the LIV
• Can cuase some aches and pains, with Rabhdo or without it
• Occurs commonly in dislipidimic agents
• Grapefruit juice – increases level of statins. Narginine, inhibitor of
metabolism and found in grapefruit.
 Fibrates
• Beneficial in people with high LDL
• Take with food to eliminate discofort
• Gallstones can occur b/c of shift in bile
• Can get myopathy, similar to statins
 Ezetimbe (ezetrol)
• Cholesterol absorption inhibitor
• Can be taken in combination with statin or with fenofibrate
• MONOTHERAPY – decrease LDL – 16%, increase HDL – 3.5%
• Side effects: myopathy, Rhabdomolysis
• Drug Interaction – cyclosporine
 Bile Acid Sequesterants
• Binds the bile acids
• Decrease in bile acids therefore the liv will want to increase bile
production
 Dyslipidemia and Naturopathic Therapies
• Has statin basis
• If have red yeast, increased chance of Rhabdomyolisis
22/03/2007 16:57:00
22/03/2007 16:57:00